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False Claims Act (FCA) Medicaid False Implied Certification Theory

Foley Hoag LLP - White Collar Law &...

White Collar Year in Preview: False Claims Act Trends in 2020

Editors’ Note: This is the fourth in our start-of-year series examining important trends in white collar law and investigations in the coming year. Our previous entry discussed anti-corruption trends in 2020. Up next: a look...more

Morgan Lewis

Ninth Circuit Panel: Escobar Test for Implied Certification Liability Is Mandatory

Morgan Lewis on

Unless and until the US Court of Appeals for the Ninth Circuit, “en banc, interprets Escobar differently,” a Ninth Circuit panel, relying on past case law, has ruled that relators seeking to establish False Claims Act...more

McDermott Will & Emery

Health Care Enforcement Quarterly Roundup - Q2 | July 2018

McDermott Will & Emery on

Following our inaugural installment of the Health Care Enforcement Quarterly Roundup, we are pleased to be back this quarter with another overview of key enforcement trends in the health care industry. In this issue, we...more

Bricker Graydon LLP

Mental health provider faces False Claims Act lawsuit due to alleged unlicensed, untrained and unsupervised personnel

Bricker Graydon LLP on

After a federal judge denied its motion to dismiss the case, a Massachusetts mental health provider, formerly known as South Bay Mental Health Center, Inc. (South Bay), faces claims under the federal False Claims Act and the...more

Sheppard Mullin Richter & Hampton LLP

What Have We Learned About False Claims Act Litigation in the Two Years Since Universal Health Services, Inc. v. United States ex...

Summer is almost here. For some, that means planning vacations to the beach, hitting the gym to shed that winter weight, or perhaps hitting the golf course—but for us at the Sheppard Mullin Healthcare Law Blog and the False...more

Robinson+Cole Health Law Diagnosis

Escobar Compels Florida District Court to Overturn $350 Million Jury Verdict Arising from Claims of Inadequate Documentation

Last month, a U.S. District Court in the Middle District of Florida overturned judgments totaling $347,864,285 returned by a jury under the federal False Claims Act (FCA) and Florida’s state equivalent against the owners and...more

Morgan Lewis

Federal Court Strikes Massive False Claims Act Verdict Following Landmark Escobar Ruling

Morgan Lewis on

The ruling in Universal Health Services, Inc. v. Escobar "rejects a system of government traps, zaps, and zingers that permits the government to retain the benefit of a substantially conforming good or service but to recover...more

Dorsey & Whitney LLP

Applying Escobar’s Materiality Standard, Florida Federal Court Reverses $350 Million False Claims Act Verdict against a Nursing...

Dorsey & Whitney LLP on

If the government does not take action and continues to pay for Medicare/Medicaid claims after it learns of non-compliance related to the claims, is the non-compliance material to the government’s decision to pay? This is a...more

Akerman LLP - Health Law Rx

Florida Federal Court: Escobar Requires Reversal of $348 Million False Claims Act Jury Verdict

The United States District Court for the Middle District of Florida vacated a large jury verdict in a False Claims Act case against the owners and operators of nursing homes because the evidence did not satisfy the...more

Alston & Bird

Implied False Certification Liability Under the False Claims Act: How the Materiality Standard Offers Protection after Escobar

Alston & Bird on

The False Claims Act (FCA), initially enacted in 1863 during the Civil War, was sponsored by the Lincoln administration to curtail the rampant fraud and excessive profiteering being perpetuated by government contractors, who,...more

Troutman Pepper

Lessons From a Year of Escobar

Troutman Pepper on

It has been one year since the U.S. Supreme Court’s landmark ruling in Universal Health Services v. United States ex rel. Escobar, which resolved a circuit split as to the validity of the implied false certification theory...more

Mintz - Health Care Viewpoints

Implied False Certification Theory Fails in FCA Case Against Billing Agent

A court in the Southern District of New York (“SDNY” or the “Court”) recently released an important decision applying the Supreme Court’s landmark Escobar ruling to a qui tam action involving percentage fee arrangements for...more

King & Spalding

SDNY District Court Judge Rules Escobar FCA Test Is Mandatory

King & Spalding on

District courts nationwide have been split on the issue of whether the two-part falsity test set forth in the U.S. Supreme Court’s opinion in Universal Health Services v. Escobar must always be satisfied in federal False...more

Manatt, Phelps & Phillips, LLP

Escobar's Impact: Recent Application of "Materiality" in Ninth Circuit

Last year, a unanimous U.S. Supreme Court decided Universal Health Services, Inc. v. United States ex rel. Escobar (Escobar), 136 S.Ct. 1989 (2016), creating important implications for Federal False Claims Act (FCA) cases...more

Farrell Fritz, P.C.

“Implied Certification” Theory Allowed Under the False Claims Act

Farrell Fritz, P.C. on

The Supreme Court recently allowed liability through the implied certification theory of the False Claims Act (FCA), which was raised and upheld in Universal Health Services, Inc. v. United States ex rel. Escobar. The...more

WilmerHale

Materiality Under FCA: The Lower Courts Grapple With Escobar’s Meaning

WilmerHale on

The Supreme Court’s decision in Universal Health Services v. Escobar ex rel. United States sought to clarify the standard for materiality under the False Claims Act, but lower courts have already begun to adopt different...more

Arnall Golden Gregory LLP

The First Circuit Rules On Materiality And Rule 9(b) In Two FCA Opinions

On November 22, 2016, the United States Court of Appeals for the First Circuit issued two False Claims Act (FCA) opinions in the continuing debate over the parameters of the FCA. In United States ex. rel. Escobar et al. v....more

Bass, Berry & Sims PLC

On Remand, First Circuit Finds Violations in Escobar Were Material

Bass, Berry & Sims PLC on

In June, the Supreme Court issued Universal Health Services, Inc. v. U.S. ex rel. Escobar, a landmark opinion in which the Supreme Court addressed the standard for pleading materiality in FCA implied certification cases. The...more

Bass, Berry & Sims PLC

North District of California Misconstrues Express False Certification Liability

Bass, Berry & Sims PLC on

This summer, the Northern District of California issued an opinion in an intervened case that expanded the theory of express false certification to a startling degree. Ruling on a motion to dismiss, the court in U.S. ex rel....more

Foley & Lardner LLP

Supreme Court Implied False Certification Case Reargued to First Circuit

Foley & Lardner LLP on

On Tuesday, October 25, 2016, a three-judge panel of the United States Court of Appeals for the First Circuit heard argument in United States ex rel. Escobar, et al. v. Universal Health Services, Inc. This case was sent back...more

Burr & Forman

The Materiality Standard In False Claims Actions

Burr & Forman on

The Supreme Court decided Universal Health Services v. U.S. ex rel. Escobar on June 16, 2016 in which it ruled the implied false certification theory, previously recognized in several circuits, can form the basis for False...more

WilmerHale

Pratt's Government Contracting Law Report

WilmerHale on

In a unanimous decision, the U.S. Supreme Court recently upheld the “implied certification” theory of liability under the False Claims Act, while emphasizing that only material misrepresentations are actionable. In this...more

Manatt, Phelps & Phillips, LLP

Health Update - July 2016

The Vulnerability of Healthcare Information - According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more

Manatt, Phelps & Phillips, LLP

Corporate Investigations and White Collar Defense - July 2016

“Official Acts”—What They Are… and Are Not - Why it matters: On June 27, 2016, the Supreme Court decided McDonnell v. U.S., holding that, for purposes of the federal public corruption statutes, an “official act”...more

Sheppard Mullin Richter & Hampton LLP

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

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